Midterm Results After Simultaneous Carotid Artery Stenting and Cardiac Surgery
Igor Zivkovic1, Petar Vukovic2, Petar Milacic2
1Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia.
Insights
The hybrid procedure combining carotid stenting and cardiac surgery is a safe and effective treatment for patients with both heart and carotid artery disease, showing encouraging early and midterm results.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Surgery
Background:
- Carotid artery disease is a significant risk factor for stroke during cardiac surgery.
- Optimal management for patients with concurrent heart and carotid artery disease remains unclear.
- The hybrid procedure, combining carotid stenting and cardiac surgery, aims to reduce perioperative complications.
Purpose of the Study:
- To evaluate the early and midterm outcomes of the hybrid procedure for patients with concomitant heart and carotid artery disease.
Main Methods:
- A total of 54 patients underwent the hybrid procedure between November 2012 and November 2018.
- Primary endpoints included perioperative stroke, transient ischemic attack (TIA), myocardial infarction, bleeding, and mortality.
- Mean follow-up duration was 30 months.
Main Results:
- The 30-day mortality rate was 0%.
- Periprocedural stroke and TIA incidence were 1.9% and 7.6%, respectively.
- Midterm follow-up revealed a 3.8% mortality due to stroke, with low rates of restenosis and no repeat thoracotomy for bleeding.
Conclusions:
- The hybrid procedure demonstrates safety and efficiency in managing patients with combined carotid and cardiac conditions.
- Low perioperative complication rates and favorable midterm results support its use.
- This approach offers a promising solution for a complex patient population.
Background:
The presence of carotid artery disease is known risk factor for perioperative stroke in cardiac surgery. The optimal management of patients with concomitant heart and carotid artery disease is not known. Simultaneous or staged carotid endarterectomy has been proposed to prevent stroke. In an attempt to reduce perioperative morbidity and death, simultaneous carotid stenting and cardiac surgery were implemented (hybrid procedure). This study evaluated early and midterm results after the hybrid procedure.
Methods:
From November 2012 through November 2018, 54 patients (36 men; an average age, 65.8 ± 7.3 years) underwent the hybrid procedure. The primary end points were the occurrence of perioperative cerebral stroke, transient ischemic attack (TIA), acute myocardial infarction, bleeding, or death. The mean follow-up period was 30 months.
Results:
The 30-day mortality was 0%. Periprocedural incidence of stroke and transient ischemic attack were 1.9% and 7.6%, respectively, and acute myocardial infarction occurred in 1 patient (1.9%). No patients required repeat thoracotomy for bleeding. Four patients (7.6%) died during follow-up. The cause of death was stroke in 2 patients (3.8%), heart failure in 1 (1.9%), and multiorgan failure in 1 (1.9%). In-stent restenosis of the carotid artery occurred in 1 patient (1.9%).
Conclusions:
In this small group of patients, the hybrid procedure proved to be a safe and efficient treatment for patients with concomitant carotid and cardiac diseases. The low rate of perioperative complications and good midterm results are encouraging.
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